Smoking is the leading preventable cause of morbidity and mortality in the United States. Primary care physicians (PCPs) have a unique opportunity to engage patients to quit smoking, but there is limited use of patient centered outcomes research (PCOR) evidence about smoking cessation in primary care. To be effective, clinicians must be able to personalize evidence-based interventions that are useful and appealing to patients in a time efficient manner. Innovation: This application will develop and test a tablet-based mHealth application (e-Quit worRx(tm)) to assist PCPs in disseminating PCOR evidence to support shared decision making about smoking cessation while minimizing clinical time burden. By pairing technology innovation with practice based research, our goal is to increase shared decision making between patients and their physicians around smoking cessation. Approach: Our first aim is to develop an acceptable and usable smoking cessation decision aid that incorporates PCOR evidence into a tablet-based mHealth application. With our technology partners, we will use input from practice based research network (PBRN) primary care physicians and patients and regional tobacco cessation experts to develop and iteratively perform usability testing of the e-Quit WorRx app. The app will assist patients in a physician's office to assess stages of change, smoking knowledge and guide them through evidence-based support options, including text and online message programs, existing apps, local support groups and medications. A summary screen prepared for the physician will foster discussion and shared decision making. Our second aim is to pilot test the app to enhance patient-centered shared decision making about smoking cessation compared to a generic pamphlet in primary care offices. Again, using our PBRN practices, we will use a stepped wedge approach to test the app in three diverse primary care practices. Patient-centered outcomes will include shared decision making, decisional conflict, and quality of patient-physician communication. Secondary outcomes will include app use feasibility in the practice and smoking-relevant outcomes including the patient's selection of smoking cessation method, stage of change progression, and self-reported smoking cessation rates after 12 weeks. Impact: This project seeks to address the gap between PCOR evidence for smoking cessation and its lack of use in primary care in a highly innovative fashion, developing and evaluating with primary care physicians and patients a new mHealth app. The mHealth components are likely to yield a large impact, as mobile technologies are widely used, inexpensive, appealing, and already integrated into most patients' everyday lives.